MEDICARE: DR. THOMAS FRANCIS BODUCH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	14330	TN
2	208D00000X	General Practice Physician	MD0000014330	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0086951	OTHER	TN	BLUECROSS BLUESHIELD OF TENNESSEE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770588741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS FRANCIS BODUCH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1030
Second Line	:
City	:	KINGSTON
State	:	TN
Zip	:	37763-1030
Country	:	US
Telephone Number	:	865-376-1212
Fax Number	:	865-376-0010

Provider Business Practice Location Address
First Line	:	314 E SPRING ST
Second Line	:
City	:	KINGSTON
State	:	TN
Zip	:	37763-2839
Country	:	US
Telephone Number	:	865-376-1212
Fax Number	:	865-376-0010

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	01/10/2012

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